How the proliferation of Catholic-owned health facilities may complicate access to reproductive care

The 10 largest Catholic systems operate about 860 urgent cares, 385 ambulatory surgery centers and about 280 physician groups, according to the report.

Catholic facilities must follow ethical and religious directives that say they cannot provide abortion or sterilization services and cannot “promote or endorse” contraceptives. The directives, approved by the U.S. Conference of Catholic Bishops, dictate how care is delivered in Catholic institutions, which includes clinics, urgent care and care provided by chartered physicians.

Religious restrictions are quickly spreading beyond Catholic hospitals as they acquire physician practices and outpatient facilities, said Lois Utley, senior counsel at Community Catalyst, which co-authored the 2020 report on the growth of Catholic health systems.

The Catholic Health Association disputed Utley’s study and questioned its accuracy when it was published in 2020. At the time, the CHA said one in seven beds were in Catholic hospitals, not one in six. At the time, the organization said it disputed Community Catalyst’s methodology.

Still, the two largest Catholic health systems alone control a wide range of health services that cover much of the country.

As of March 31, Ascension says it has 40,000 “aligned” providers in a total of 2,600 treatment locations in 19 states, while CommonSpirit has 25,000 physicians and advanced clinical practitioners in 21 states and 1,500 treatment locations.

Neither Ascension nor CommonSpirit responded to requests for comment.

Abortion is expected to remain legal in half the country

Abortion laws by state

It is not always clear to patients how care can be influenced by religious institutions. A 2019 JAMA report found that only 28 percent of Catholic hospitals disclose how their religious affiliation may dictate care.

This lack of transparency can lead to dire health situations for pregnant people who come to Catholic hospitals with complications. There are reports of women presenting with miscarriage complications but being turned away due to Catholic hospitals’ religious guidelines. If not treated in time, the complication of miscarriage can become life-threatening for the pregnant woman.

Although Catholic institutions cannot perform abortions, there are some exceptions. Still, it’s not always clear when Catholic hospitals can step in to save the mother’s life, and in those cases, medical facilities usually convene the hospital’s ethics committee to determine a course of action.

The US Conference of Catholic Bishops has said there is a difference between what it considers a “direct” abortion and a “legitimate” medical procedure.

In the 2010 guidance, the conference explained that a medical procedure that “indirectly” terminates a pregnancy is permissible, such as in the case of a pregnant woman who has been diagnosed with uterine cancer. Removing a cancerous uterus “directly” addresses the medical problem and “indirectly” terminates the pregnancy, according to the U.S. Conference of Catholic Bishops.

However, if a pregnant woman experiences organ complications due to the “additional burden of pregnancy”, abortion is not permissible because it is considered a “direct” abortion.

The bishops released the guidelines after a Catholic hospital in Phoenix performed an abortion to save the life of a 27-year-old mother of four in 2009. Phoenix Bishop Thomas Olmsted condemned the procedure, although the mother reportedly survived.

A nun who was also a hospital administrator allowed the abortion and was excommunicated from the church for her actions, according to a previous report by NPR. The bishop also stripped the hospital of its Catholic affiliation, ABC News reported.

In some states where abortion remains legal, Catholic health care facilities have a large presence, and lawmakers should work to make transparency at those facilities a priority, said Marian Yarlensky, a professor at the University of Pittsburgh School of Public Health. Yarlenski co-authored a Catholic hospital market share study.

“I think a very clear policy response would be to say, ‘OK, any health care facility that receives any public dollars — Medicare, Medicaid — should be required to make it very clear what services are and are not available,'” Yarlensky said.

In 10 states, more than 30 percent of emergency room beds are in Catholic hospitals, which includes Colorado, Oregon and Washington. These are states that have pledged to preserve access to abortion.

In Illinois, Catholic facilities account for about 28% of hospital beds.

“The proliferation of faith-based health care absolutely raises concerns about patient access to reproductive health care,” said Amery Clafetta, director of women’s and reproductive rights at the American Civil Liberties Union of Illinois.

“We also know that there are parts of the state where there may be very limited health care options. So there may be parts of the state where, in effect, the only available health care — either by location or by insurance limitations — may be a religious institution,” Clafetta said.

The ACLU of Illinois filed a lawsuit in 2018 after a woman was denied long-acting, reversible birth control at a Catholic facility in Chicago.

The majority of abortions in the U.S. are performed in clinics, while only 5 percent of abortions are performed by hospitals, according to a 2017 analysis of abortion rates by the Guttmacher Institute.

Catholic institutions operating more urgent care clinics, physician groups and outpatient facilities have raised concerns about complicated access to contraceptives and Plan B, an emergency contraceptive commonly called the morning-after pill that is used to prevent pregnancy.

“There may be areas in these states where that care is quite limited” because hospitals tend to operate outpatient facilities, urgent care and operate physician practices in the areas where they own hospitals, Community Catalyst’s Utley said.

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